Cirrhosis
This condition is specifically known as liver cirrhosis. It is the result of chronic liver disease that causes scarring of the liver and liver dysfunction.
The liver, the largest organ in the body, is solely responsible for removing germs, bacteria and poisons from the blood, producing immune agents to control infection making proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. So when this multi-functional organ is disabled, various kinds of grim complications can arise.
As cirrhosis leads to an inability of the liver to perform its biochemical functions, it can also cause abnormalities in other organ systems.
Cirrhosis of the liver results from damage to liver cells from toxins, inflammation, metabolic derangements and other causes. These damaged and dead liver cells are replaced by fibrous tissue, leading to fibrosis (scarring). Soon the scar tissue replaces normal, healthy tissue, inhibiting blood from flowing through the organ.
Cirrhosis is characterized anatomically by widespread nodules in the liver combined with fibrosis. Liver cells regenerate in an abnormal pattern primarily forming nodules that are surrounded by fibrous tissue, eventually causing an abnormal liver architecture.
Causes
Cirrhosis can result from any chronic liver disease:
Alcoholic liver disease
Chronic alcoholism is most often associated with cirrhosis of the liver. Because alcohol blocks the normal metabolism of protein, fats, and carbohydrates.
Alcoholic cirrhosis usually develops after more than a decade of heavy alcohol abuse. The amount of alcohol that can cause liver injury is not generic. It varies from person to person. In women, even two to three drinks a day can lead to cirrhosis, whereas in men, it takes about three to four drinks a day.
Chronic hepatitis C
Next to excessive alcohol consumption, the hepatitis C virus is a major cause of liver cirrhosis. The infection leads inflammation of the liver and deterioration of the liver capacity over a long period.
Chronic hepatitis B and D
The hepatitis B virus is less common among western countries, but it is the number one killer in the developing and under-developed countries.
Similar to hepatitis C, this virus causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.
Autoimmune hepatitis
This disease is caused by the immune system attacking the liver. Resulting in liver inflammation, liver damage and eventually scarring and cirrhosis.
Inherited diseases
Some inherited diseases such as alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia and glycogen storage diseases interfere with the way the liver produces, processes and stores enzymes, proteins, metals and other substances the body needs to function properly.
Nonalcoholic steatohepatitis (NASH)
Here, fats builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease and use of corticosteroid medications.
Blocked bile ducts
When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a condition where the bile ducts are absent or injured.
In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked and scarred. Bile products deposited in the skin may cause intense itching. If cirrhosis prevents bile from reaching the gallbladder, gallstones may also develop. In addition, secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.
Drugs, toxins, and infections
Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.
Risks
Liver dysfunction affects the body in more ways than one. The most critical outcome of cirrhosis is Hepatocellular carcinoma, a type of liver cancer, which starts in the liver tissue itself. It has a high mortality rate.
Cirrhosis can result in immune system dysfunction, leading to various types of infections. It can also lead to impotence, kidney dysfunction and failure, and osteoporosis. Some of the other complications include:
Coagulopathy
This is a bleeding disorder. Blood can back up in the spleen causing it to enlarge and sequester blood cells. Most often, the platelet count falls because of spleen sequestration leading to abnormal bleeding.
Also, with the liver slowing down or reducing production of the proteins needed for blood clotting, a person will bruise or bleed easily. The palms of the hands may be reddish and blotchy with palmar erythema.
Fluid accumulation
One of the biochemical malfunctions includes a fall in the serum albumin concentration. When the liver loses its ability to make the protein albumin, fluid accumulates in the legs (edema), abdomen (ascites) and the peripheral tissue (peripheral edema).
The condition worsens with hypertension in the portal circulation combined with other hormonal, metabolic and kidney abnormalities in cirrhosis. This is accumulation of fluid in the abdomen often becomes infected with bacteria normally present in the gut.
Hepatic encephalopathy
In advanced cases, profound abnormalities in the brain can develop. A damaged liver cannot remove toxins from the blood. This malfunction enables toxic metabolites, which are normally removed from the blood by the liver, accumulate in the blood and eventually the brain.
In its early stages, subtle mental changes such as poor concentration, the inability to construct simple objects, neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleep habits occur. In severe cases, hepatic encephalopathy can lead to stupor, coma, brain swelling and even death.
Gynecomastia
This is breast enlargement in men, which sometimes occurs because metabolism of estrogen in the liver is decreased.
Derangements in the metabolism of triglycerides, cholesterol and sugar can also occur. In earlier stages, cirrhosis frequently can cause insulin resistance and diabetes mellitus. In later stages or in severe liver failure, blood glucose may be low because it cannot be synthesized from fats or proteins.
Cirrhosis also slows the liver's ability to filter medications from the blood. Adverse reactions may be expected as the drugs remain in the bloodstream longer than expected and build up in the body.
Signs & Symptoms
In many cases, symptoms are not found in the early stages of the disease. But as the condition progresses, the following indications may be noticed:
Exhaustion
Fatigue
Loss of appetite
Nausea
Weakness
Weight loss
Abdominal pain
Spider angiomas - spider-like blood vessels that develop on the skin
In later stages, serious complications develop. Though in some people, these may be the first signs of the disease:
Ascites
Swelling of the legs / Overall swelling
Vomiting blood
Confusion
Jaundice
Small, red spider-like blood vessels on the skin
Weakness
Weight loss
Nausea and vomiting
Impotence and loss of interest in sex
Bleeding hemorrhoids
Decreased urine output
Pale or clay colored stools
Nosebleed or bleeding gums
Gynecomastia (breast development in men)
Abdominal pain and indigestion
Constanty fevers
In many, symptoms don't show till the disease reaches the final stage.
Diagnosis
The doctor may diagnose cirrhosis on the basis of symptoms, medical history, physical examination and laboratory tests such qas:
Computerized axial tomography (CAT) scan
Ultrasound
Magnetic resonance imaging (MRI)
A scan of the liver using a radioisotope
Liver examination using a laparoscope
A physical examination may reveal an enlarged liver or spleen, distended abdomen, yellow eyes or skin in case of jaundice, red spider-like blood vessels on the skin, excess breast tissue, small testicles in men, reddened palms, contracted fingers, or dilated abdominal wall veins.
Tests can reveal the following liver problems that indicate cirhossis:
Anemia
Coagulation abnormalities
Elevated liver enzymes
Elevated bilirubin
Serum albumin low
Enlarged liver
Cirhossis may also abnormalities in the following tests:
Cholesterol test
Alpha-fetoprotein
Renin
Serum magnesium - test
Finally, a liver biopsy will confirm the diagnosis. A tiny sample of liver tissue is extracted using a needle for the biopsy.
Prevention
Some precautions can be taken to prevent liver cirrhosis:
Avoid excessive drinking. If you have an alcohol problem, seek professional help as soon as you notice the first signs of addiction.
Avoid intravenous drug use. When you do, make sure you use only clean needles and never share needles. This will reduce the risk of hepatitis B and C.
Avoid snorting drugs or sharing any related paraphernalia. There are chances of contracting hepatitis C through shared use of straws or items used to snort cocaine or other drugs.
Treatment
Treatment is only aimed at arresting or delaying further progression of the disease, as liver damage from cirrhosis cannot be reversed. Treatment can also complications and damage to other organs.
The cause of cirrhosis determines the course of treatment. In fact, removing the cause is the first step in treating this condition. If alcohol abuse is the underlying cause, abstaining from alcohol is critical in alleviating the symptoms and preventing further complications.
Hepatitis-related cirrhosis
This involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis.
Cirrhosis caused by Wilson's disease
In this case, copper builds up in the organs, which is treated with medications to remove the copper.
Similarly, treatment for cirrhosis resulting from other diseases depends on the primary cause. But regardless of the cause, following a healthy diet and avoiding alcohol are essential to give the body a fair chance in fighting the disease. Light exercise is also important in order to build the body's resistance.
Treatment will also have to focus on providing remedies for other complications that arise:
For ascites and edema, a low-sodium diet or the use of diuretics, which are drugs that remove fluid from the body, are recommended.
Antibiotics will be prescribed for infections and various medications can help with itching.
A low protein diet is advised as protein causes toxins to form in the digestive tract. Eating less proteins would help decrease the buildup of toxins in the blood and brain.
Laxatives are also prescribed to help remove the toxins from the intestines.
For portal hypertension, a blood pressure medication such as a beta-blocker is prescribed.
Bleeding esophageal varices can be treated with endoscopic sclerotherapy or rubber band ligation, where a special device is used to compress the varices and stop the bleeding.
A liver transplant is the last resort, when complications cannot be controlled or when the liver becomes so damaged from scarring that it completely stops functioning. Survival rates, among patients who have undergone liver transplantation surgery, have improved over the past several years because of drugs such as cyclosporine and tacrolimus, which suppress the immune system and keep it from attacking and damaging the new liver. But, liver transplantation is usually not performed in patients more than 70 years old.
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